Convulsive Status Epilepticus:

Infants (Age >1 month), Children and Adolescents Guideline

Manage in Resuscitation Area
888 Call If Seizure Unresponsive To 1 Dose of Benzodiazepine or Airway Compromise at any time
Continue down algorithm until seizure ceases - Full guideline on Southnet

Airway management
High Flow O2
Obtain Blood Glucose if BSL < 3.0 give 2ml/kg of 10% Dextrose

Consider pre-hospital treatment.

More than 2 doses IN TOTAL of Benzodiazepines should only be given only after discussion with SMO

Yes Intravenous (IV) or Intraosseous No

(IO) Access?

IM Midazolam 0.2mg (Max 10mg)

OR
Lorazepam 0.1mg/kg (Max 4mg ) Buccal or Intranasal Midazolam
Given by slow push 0.5mg/kg (Max 10mg)
OR
Midazolam 0.15mg/kg (Max 10mg)
OR
Diazepam 0.25mg/kg (Max 10mg) Achieve IV access or if
seizure continues after
5 minutes and no IV 10 min
5 min access insert IO

Lorazepam 0.1mg/kg (Max 4mg ) IV or IO Access

Given by slow push
OR
IM Midazolam 0.2mg (Max 10mg)
Midazolam 0.15mg/kg (Max 10mg) 2nddose of Benzodiazepine given OR
OR
10 minutes after IM/Buccal or IN route Buccal or Intranasal Midazolam
Diazepam 0.25mg/kg (Max 10mg)
0.5mg/kg (Max 10mg)

5 min IV or IO Access

2nd line agents

Phenytoin 20mg/kg over 20minutes (Max 1g)
OR
Phenobarbitone 20mg/kg over 20minutes (Max 1g)

20 min

3rd line agents

Phenobarbitone 20mg/kg IV over 20minutes (Max 1g)
Sodium Valproate 30mg/kg over 10minutes (Max 1200mg)
Levetiracetam 40mg/kg IV over 5minutes (Max 3g)

If seizure continues after ONE 3rd line Agent OR AIRWAY Compromise at anytime
consider RSI in Consultation with SMO and ICU

Kidz First Emergency Care

Issued: 24/02/2014